"Did he call me a sewer?” Ann Patchett asked her sister after the clip of a local news story had finished streaming across her computer.

“I think he’s saying the book is a sewer,” her sister replied. “Or the circumstances are sewerlike. I don’t think you yourself are a sewer.”

The speaker in question was Ken Wingate, a South Carolina lawyer and local also-ran for the state senate and governorship. The sewer he claimed to have waded into involved Patchett’s book, Truth & Beauty: A Friendship, which had been assigned to the incoming Clemson University freshman class of 2006 as mandatory summer reading. Modeled after the ever-popular book club, the idea was to bring classmates together through a common reading experience. There would be discussion groups, writing assignments, and, as a final treat, a reading and talk from the author herself. But soon after the text was assigned, a handful of parents began voicing concerns that the book was inappropriate reading material. Led by Wingate, they pointed out that the book included pornography, fetish, masturbation, multiple sex partners, and antireligious sentiments—and claimed that all of this served one purpose, and one purpose only: “The explicit message this that sends to students is that they are encouraged to find themselves sexually.”

In fact, Truth & Beauty is Patchett’s account of her friendship with her best friend and fellow writer, Lucy Grealy, who had died three years prior at the age of 39. Author of her own memoir, Autobiography of a Face, Grealy endured 30 years of pain and suffering as she underwent 38 reconstructive surgeries in an attempt to fix her jaw, which had been disfigured by childhood cancer. Patchett and Grealy had met in college but became close in graduate school at the Iowa Writers Workshop where they studied creative writing. “[Truth & Beauty] was a story of a Herculean effort to endure hardship, and to be a friend,” Patchett writes in the Fiction issue of The Atlantic. “Even when the details of our lives became sordid, it was not the stuff of sewers.”

In the face of provocative television news segments, an inflammatory full-page ad in The Greenville News, and an outpouring of letters from angry parents and alumni calling for the cancellation of the author’s scheduled appearance on Clemson’s campus, Patchett decided to speak to the Clemson class of ’06 anyway—even though that meant accepting protection from a bodyguard. On stage in Littlejohn Coliseum, she spoke of the right to read and the importance of drawing one’s own conclusions. She made note of all the great works of literature that had, at one point or another, been similarly criticized as morally unsuitable, and she wondered aloud what purpose higher education served if not to acquaint oneself with the complex, real world:

If stories about girls who are disfigured by cancer, humiliated by strangers, and turn to sex and drugs to escape from their enormous pain are too disgusting, too pornographic, then I have to tell you, friends, the Holocaust is off-limits. The Russian Revolution, the killing fields of Cambodia, the war in Vietnam, the Crusades, all represent such staggering acts of human depravity and perversion that I could see the virtue of never looking at them at all.

The speech and visit won substantial support and applause, though not from all young members of the audience—some of whom took it as a public opportunity to question Patchett’s own morals to her face. From her home in Nashville, Patchett talked about her experience at Clemson, her writing process, and her friendship with Lucy Grealy. We spoke by phone on May 30th.

—Abigail Cutler

In your essay and in other interviews, you’ve described how writing Truth & Beauty was part of your mourning process, that it helped heal you after Lucy died. Do you think going to Clemson had any place in that process?

Absolutely not. My experience at Clemson was so much about me catching up with what was going on. And while I shouldn’t have been blindsided by what happened there—as it had been clearly laid out for me well in advance—I just never thought things were going to be as bad as they were. My emotional energy was really spent trying to get up to speed with what their criticism was all about.

At Clemson (and during the aftermath) I was thinking about myself, not about my dear, dead friend. If the Clemson experience had come earlier, closer to when Lucy died, it might have been more detrimental to my grieving process—it might have made me feel sad or defensive of her. But by the time I went to Clemson, enough time had passed. I had already grieved for her. I felt at peace with what happened and didn’t feel vulnerable in terms of her. I did, however, feel vulnerable in terms me—of being personally attacked.

When I think about how my experience there related to Lucy, I try very hard not to ever say, “Oh Lucy would have loved that,” or, “Lucy would have done this.” I try not to speak for the dead. And people do put me in that position all the time—they ask, “Wouldn’t Lucy have loved this?”

Do they ask, “What would Lucy have said?”

Yes, exactly. What Would Lucy Do—WWLD? And it’s true: Lucy would have torn them to kibble. And with such articulate glee. Lucy was just always up for a scrap. And she was so good at that. I would have loved to see her take them apart. Thinking about that, actually, was helpful. When I was feeling sorry for myself afterwards—and I did feel sorry for myself—I finally stopped and thought, you know, why exactly does this hurt so much? Who is being attacked here? I ultimately realized those people at Clemson weren’t judging Lucy; they were judging me. I think that also helped me feel like I wasn’t dragging her and her memory into something bad. One of the kids asked that question—“You talk about how so many people judged Lucy, but aren’t you just heaping more judgment onto her?”—which is such a funny way of thinking about things. As if it were better not to bring things up for fear she might only be further judged.

You mention that Ken Wingate’s criticism of your book left you completely blindsided. Had you ever before come across anything that resembled it?

No. I felt completely taken aback by it, and completely unprepared to respond. It had been such a love fest up until that point; if anything, the criticisms of the book had erred on the side of, “It’s too sweet, too gentle.” That mattered to me. I felt slightly embarrassed to win that American Library Association award—I mean, of course I was grateful for the award, but they had conceived of the book as being “Most Suitable for Teens,” which made me think I had made a mistake, that the book didn’t effectively get its message across. Don’t get me wrong, I think this is a great book for kids and I don’t worry that they’d find anything especially surprising in it. I imagine kids know all sorts of dirty things that I don’t know the first thing about…

In my childhood, the quintessential naughty book for teens was Go Ask Alice. And I couldn’t put it down.

Yes! Go Ask Alice. I read that in my childhood, which suggests that as early as the ’70s, kids had much more scandalous memoirs to read than Truth & Beauty. I remember that book as so scandalous, but I loved it. I read it over and over again. And really, I’m not sure there has ever existed a better anti-drug message! I think I would have done worse things had I never read that book.

Watch an excerpt from Ann Patchett's speech

I watched the entire tape of your speech at Clemson. You were incredibly poised on that stage, even in the face of some pretty insensitive judgment and presumption. It’s hard for me to think you weren’t angry. Is there anything in retrospect that you wish you had thought to say or do—particularly in response to that one student’s question about your marital fidelity?

Sure, in retrospect, it’s tempting to wish I had said, “Hey kid—fuck you!” And after the event, so many of my friends told me I should have, but to tell you the truth, I was really proud of myself that I didn’t tread anywhere near that, that I didn’t respond with aggression. I like to think that my years of yoga kick in at precisely such moments—that they enable me to respond to aggression with peace, which I do think is the most disarming and irritating thing you can hand to someone who’s being really combative.

But no, I don’t really know what I would have said had I had my wits about me. I didn’t even understand his question for such a long time—not just seconds or minutes, but hours. It wasn’t until I was in bed at my sister’s house that I realized he wasn’t saying, “You’re a bad person for condoning Lucy’s bad actions,” but rather, “You’re a bad person for your own bad actions.” When I later listened and watched my response—I also watched the tape, which was excruciating beyond belief—I saw myself respond with this whole thing about how we shouldn’t judge others, because I thought he was judging her. But he wasn’t judging her—he was judging me. I might have responded differently had I realized that at the time. After all, it’s one thing to judge my cancer-ridden, disfigured best friend. But if they’re judging me, I can’t very well say, “Hey, it’s not cool to judge,” because it’s too easy an out. So, I completely missed the boat. But I can put myself back there a hundred times and say confidently that it wouldn’t matter. I still would have missed it.

Also, I don’t watch television. I haven’t for years. So never having seen what I understand to be the immediate slamming criticism in American Idol and the like—where people perform and then subject themselves to public humiliation, which seems to be the object aim in so many of these shows—I really didn’t know a thing about how one should go about responding in such a situation. Hands down, the most upsetting and distressing thing about the entire Clemson experience—more than Wingate, more than anything else—was seeing in action this idea that kids could be so rude to an adult, a guest of the university, on their very first day of school. That just blew my mind. I thought, “What kind of a society are we living in?” I have since spent a lot of time thinking about the physicality of that auditorium—thinking about the darkness, how the lights didn’t work, how no one could see one another. I do wonder whether the same thing would have happened had the lights been on, had that boy been able to see my face and I his.

Some reviews of the book express surprise at your ability or desire to remain friends with Lucy. It’s been suggested that you martyred yourself—in your relationship and in this book—and that there has to be more anger or resentment than you let on in your writing. What do you say to that?

That kind of reaction or response to the book, particularly from people who didn’t know Lucy or me, makes me feel that I didn’t do a good job as a writer, that I didn’t successfully convey Lucy’s wonderfulness and what made her worth it. But then I got so many letters from readers who expressed how amazing they thought she was, how they wished she had been their best friend, how lucky I was to have known her. It makes me think that drawing both those responses means I’ve actually created a pretty accurate portrait of Lucy. In fact, it’s true that a lot of people didn’t like her, but a whole lot of people worshipped her. She elicited that strong response—she was someone who could make you feel passionately, one way or another.

That was something that I found with Bel Canto—the book did so well, and I received so much praise and love, but I also got incredible hate mail about that book. Some unbelievably hateful reviews, some that displayed a viciousness of the kind I had never seen. It was so interesting to me—perhaps you can’t elicit such a strong response of love without also eliciting a strong sense of hate as well. And it blows my mind a little bit, because while I can think of books I really hated or objected to, I really can’t imagine feeling so strongly as to write the author a piece of hate mail.

Lucy was hard, she was a challenge. And she pushed us all to our limits. I remember being in New York after I’d chosen not to call her, the night before she died, with a friend, and I remember just railing on Lucy. I was really angry with her at that point. She was destroying herself and there was nothing I could do to stop it. But that’s exactly who Lucy was and who she wanted to be. She strove to draw out that passion in people. That’s how she lived her hard, fast life.

I was especially struck by one sentence in Truth & Beauty—something a taxi driver who had brought the two of you back from the hospital said as you carried Lucy from the cab to your apartment. “What kind of woman can carry someone like that?” This line certainly speaks to your strength. But I also thought about how Lucy seemed to have instilled that in you—that she made it possible for you and her other many friends to have enough strength to carry her.

I’m not sure I’ve ever thought about it that way, but I think it’s a wonderful insight. Lucy didn’t just push us all to our limits, which she did, sometimes to our most horrible. She made me realize how much I could love someone, care for someone, take care of someone. And she really did that for all of us, all of her friends, and it was a wonderful thing. I do not think I would have become as strong of a person had I not known Lucy.

That’s actually a question a lot of people ask me after reading the book: “Would you have had a different friendship with Lucy had she never had cancer?” I say, Well, sure. She is who she is, and that is someone shaped by a terrible childhood experience. Had that not happened to her, she would have become a different person and our friendship would have been different. Another popular question is, “How would you have been different had you had never known Lucy?” My first impulse is to say that I don’t think I would have been different. But in rethinking this, I have to realize I am different because of her. I got to find out how strong I was; I never would have found that out had it not been tested over time. And that’s a good thing, to be tested, when it comes from someone who loves you.

Can you talk a little bit about the significance of the title? Was the Keats reference a tribute to Lucy? Or was it homage to Chapter 11 of her book? What does “Truth and Beauty” mean to you?

The book was originally called, DearestToMe. Not only is that a saccharine title, but also it’s really hard to pronounce—the two “ts” are impossible! One of the things you learn as a writer over the course of a lifetime is that the little things that bother you aren’t actually so little. They matter. It’s like being married—you think, OK, that little thing he does isn’t so bad; it bothers me a little bit but I can get over it. Well, if it bothers you a little bit now, it’s going to bother you a whole lot in ten years. And so things like book jackets, book titles, and photographs of yourself—like the one of me on the jacket of Patron Saint of Liars, which to this day makes me want to throw up—matter, too. You have to be really careful about these things, so two weeks before publication when I realized I could not possibly go through my life with a book called DearestToMe, I had it changed.

I imagine that still takes some courage.

Sure, but what happens is that you hear people saying it; you hear yourself being introduced at a conference, “She’s the author of DearestTo—” and you think Nooooo! Stop! Once you get those feelings, you must abort, and as soon as possible. I worried about not being able to come up with one in time, but then one night I woke up and thought, Truth&Beauty. I wrote it down on a little piece of paper next to my bed, and it was there when I woke up n the morning. I have lived long enough to know that when you wake up in the middle of the night and have a genius moment, it will vanish unless you write it down.

Months later when I was looking at Autobiographyofa Face for the 7,000th time, I suddenly realized that that “Truth and Beauty” is a chapter title from Lucy’s book. I love that I plagiarized from her, not realizing it at the time. I had actually wanted to plagiarize a different chapter title—“Be Here Now”—but I decided it lacks resonance without context. There is also the homage to Keats, of course, and that was very important, but it wasn’t perfect either. After all, what Keats actually says in “Ode on a Grecian Urn” is that the two concepts are tantamount—that “‘Beauty is truth, truth beauty,’—that is all ye know on earth, and all ye need to know.” And that is really not the message I’m selling. I have great affection and respect for that poem, as does everyone else, but it is not the Lucy Grealy message.

Ultimately I think the idea for the new title came from Lucy’s NPR interview with Terry Gross, which I had listened to the day after she died. In that interview, Lucy talks about “Truth with a capital T” and “Beauty with a capital B.” I had listened to it over and over and over again, and I think those words must have lodged somewhere in my brain. It just stuck.

What was it like to write a book without Lucy?

That wasn’t a problem. Of course, it would have been handy to be able to call her up and ask her, “Luce, I forget—where were we when…” But it is in fact the only book that I’ve ever written where it would have been really handy to have her around. I have said this before, but writing Truth & Beauty was like having a book, sticking it through the paper shredder, and then using tweezers and glue to re-assemble it. It felt so much not like writing, but like assembling—I had all these calendars and letters and diaries and dates and I was calling people with questions like, “OK, now this fellowship started there, and she was there when X and she got to Montana while I was on the Cape…” and that sort of thing.

And so she was that book, but Lucy and I were never writing friends after graduate school. We didn’t really get into each other’s work. Part of it, I think, was that I was so much more prolific than Lucy, which was often hard for her. I just didn’t want us making each other feel bad, getting competitive.

I remember when BelCanto did really well, she’d say to me, “Look at what a really good job I’m doing being happy for you, not being jealous, and not hating you for doing so well!” And she meant that. She’d say, “If I have to go outside one more day and have someone tell me how much they loved Bel Canto…” She’d claim to them that she knew right from the start that Bel Canto was going to be my big book, and it’s true—she did always say that. She was so proud of her ability to be able to love me through my success.

Why do you think it’s so hard for so many people to understand platonic love between two women?

I went to an all girls’ school. I wore my hair short; I never wore makeup. I’ve always had close female friends. And if I had a nickel for the number of times I’ve been called a lesbian… But it never bothered me. In fact, Lucy and I would often talk about how nice it would be, how much easier it might be, to be attracted to women. The notion that I might be a lesbian never bothered me. The thing that did make me really angry was the suggestion that Lucy and I simply didn’t know ourselves well enough to realize we were in a lesbian relationship. There was one article that also criticized me for calling her “pet,” suggesting I was demeaning her to the status of a dog or something. To suggest, as many did, that the only possible explanation for why I remained close with Lucy was that we were lovers was really infuriating.

In any event, Lucy and I would never have worked out as a couple. We knew each other far too well for that!

Though not a focal point of the book, I was moved by Lucy’s interest in pursuing a possible career in medicine. And I’ve noticed that Truth & Beauty has appeared on many suggested reading lists—along with other favorites by Atul Gawande, Alexander McCall Smith, and Tracy Kidder—for doctors and medical students. It got me thinking: How did your experience with Lucy shape or change your impressions or expectations of healthcare?

It’s funny—I can’t tell you the number of medical schools that have asked me to speak to their students about the book. I won’t do it. I have great respect for the profession—my stepfather was a doctor, my mother was a nurse, I’m now married to Carl, a physician—and I’ve always had very good care, been very comfortable around doctors. And as I describe in the book, I knew how to be a patient advocate. I knew how to ask for more drugs, to demand that they change the sheets, or how to do it myself if need be.

But going through all that with Lucy was its own learning experience all the same. When it’s only you in that room, when you’re the only person your friend has, it really becomes your responsibility to make sure your friend doesn’t die simply because there aren’t enough staff to attend to her. It takes just a minute for something truly horrible to happen, and it’s not as though we could do everything for her if it came down to it. None of us knew how to suction a trach tube if need be, for instance. At one point, Lucy’s friends got together and pooled our money to hire her a nurse who could be there with her when we weren’t.

Being on the other side of things can be very disillusioning. When Lucy was having her fibula bone grafted into her face—clearly a very new and specialized surgery—the doctor scheduled it for June. Why in God’s name they would do it at the end of June, before vacation and before the new interns [first-year residents] arrive, I just don’t know. It was beyond me.

The experience also, unfortunately, put a big blot on my opinion of psychiatry. I don’t blame Joe, Lucy’s last therapist, anymore, but I do think that when he fired her, that amounted to about the unkindest cut of all. After Lucy died, I talked with a lot of people who described how the worst thing that could happen to a psychiatrist or therapist was a suicide under their watch, and that it wasn’t uncommon for a doctor to fire a patient who started showing intent to kill him or herself. The ability for some of these doctors to get rid of a patient, just in order to avoid having their records marred, is something I will never be able to understand. Joe had been so chummy—almost, from my perspective, unprofessionally chummy.

But Lucy was always enamored with doctors. She always wanted to please them, to be their best patient, for them to love her most. That was her goal. Getting dumped that day—in a lifetime of getting dumped—really seemed to me to be cruel beyond words.

In your Atlantic essay, you explain: “I wrote a book about us. I wrote it as a way to memorialize her and mourn her, and as a way of keeping her own important memoir, Autobiography of a Face, alive, even as I had not been able to keep her alive.” This last clause struck me. Do you feel it was your responsibility to keep her alive? That you failed in some way when she died?

It’s so hard to be articulate about this, but I’ll try: I never thought that I could do something to save her life, but I also never thought she’d die. I never understood—which is crazy, crazy, crazy—that she would really fall apart, that I could lose her. But when I listened to other people—from her closest friends to mere acquaintances to total strangers who had read her book—talk about their grief, and I heard them say, “If only I had reached out to her”—which to me implies that they also thought they somehow had the power to save her—it felt incredibly liberating. It made me realize the extent to which I didn’t, in any way, have the ability to save her.

I have a friend, a very old childhood friend, who had a younger brother who was a drug addict. She spent her life being helpful and being tough and being constructive and doing everything the right way, and after Lucy died, after she read the book, she asked me, very sadly, “Do you feel like you enabled her?”

And I said that I wish I had enabled her so much more than I did. My onlyregret was any moment that I was ever tough with her. If I could have sat with her while she was shooting heroin, I swear to God, looking back on it, I wish I had. I wish she had never been alone in any moment that felt shameful or painful, because once you realize that you’re not going to save someone, then all you can do is love them. And I know that’s not a blanket statement and can’t apply to everyone, but I feel it does in this case.

But I didn’t feel that way at the time. There was one person, who shall remain nameless, who I felt enormous anger towards after Lucy died. He was a friend but he was primarily the boyfriend of a friend, and he had apparently always wanted to do heroin because it seemed glamorous. So he and Lucy did heroin together. I just wanted to kill him. There he was with her, validating that doing this drug was cool, glorifying heroin, and Lucy totally bought into that.

And yet now I can look back at even that and say, “Well, at least when she was shooting up that one time she wasn’t alone.” And whether that one occasion did or didn’t have any effect on how long she was going to live, I now believe so strongly—almost in a way that resembles a belief in predestination—that Lucy had a date with death. She was going there as hard as she could, and her question was not whether she was going to die, but rather, Was she alone? Was she judged? Did she feel loved? And that’s what seems so much more vital to me now than my thinking, “Oh, if only I had been much tougher, if only I hadn’t paid the rent that one time, maybe she would have…” That’s ridiculous. Nothing would have changed except that she wouldn’t have had the rent that one time, or she wouldn’t have had the heroin that one time. In retrospect, I only want her to have had everything she ever wanted.